Top 4 Reasons for Thigh Pain when Running

If you have been running for more than six months, you’ve more than likely felt the sensation of a thigh pain when running.

You know the feeling…when you’re done with the run and your hammy feels as tight as a rope.

Or when your quad feels like it is going to explode after a hill workout.

This is not always normal. If you feel it is normal, ask yourself why it only feels that way in one thigh and not the other?

Tightness and soreness from normal use is bilateral (on both sides) and equal.

In this article, I will go into the most common reasons for thigh pain when running you can experience and some corrective therapy exercises/treatments you can do if you have one of them.

Here are the top four reasons for thigh pain when running:

• Hamstring strain
• Quad Strain
• IT Band Syndrome
• Nerve Pain

HAMSTRING STRAIN

• Tightness in the back of your thigh?
• Does it start on the sit bone?
• Does it increase in track workouts?
• Is it painful to sit down?

Hamstring injuries are the downside of being fast. Sprinters actually get hamstring injuries more than distance runners, but high-level distance athletes get it more than joggers.

Let me start out by telling you, I have a PASSION for hamstrings.

I have had two hamstring tears from baseball and have gone through everything you are going through myself.

Pain with taking off my shoes and taking my foot off of the gas pedal.

I didn’t have any idea these would ever hurt with a hamstring injury until I had mine.

So I understand.

Thigh pain when running

What is a Hamstring Strain?

A Hamstring Strain is an injury to where the muscle and tendon parts of one of the hamstring muscles normally come together. It can happen anywhere along this musculotendinous junction, but common places are the belly region and where the hamstring attaches to the pelvis.

Pain at the sit bone is normally called High Hamstring Tendinitis, a High Hamstring Strain or Upper Hamstring Pain.

If the lower portion is damaged, most people call it Lower Hamstring Tendonitis or a Distal Hamstring Strain.

Regardless of where it is, a strain is a Grade I hamstring tear. It is not just an upset muscle. It is a real injury so you need to treat it as such or it will only get worse.

What causes a Hamstring Strain?

Hamstring Strains are caused by overuse or over demand of the muscle/tendon complex.

I have found it is more common for over demand to be the issue.

Over demand from gait changes or over striding can be major reasons why one hamstring is being forced to work overtime.

Muscular imbalance is another major reason for thigh pain when running.

In this category, we can also throw in a few regions of possible weakness or lack of endurance. Here are a few of the first spots I look at:

• Core/Trunk
• Low Back
• Glutes

The reason these regions of the body are so important is because the hamstrings attach to the pelvis, which is held in proper position by all of these muscle groups.

Therefore, these muscle groups directly affect proper running form or gait.

If they are weak or lack endurance, your form WILL degrade and your hamstring will tear.

To get specific, tears occur because the hamstring’s length-tension relationship changes.

How can you rehab a Hamstring strain?

I’m not going to lie…hamstring rehab is a long process.

It is frustrating, and you will experience a flare-up, so just expect it from the start.

Rehab includes:

• Treatments/exercises to decrease pain
• Exercises for local rebuilding of the hamstring muscle fibers
• Core/Hip rehab and gait retraining so it doesn’t happen again

Hamstring self-myofascial release

Here is the same style lacrosse ball work for High Hamstring Tendonitis:

Once we are to the loading phase, I like to prep the motion with a dynamic activity such as Good Mornings:

After, we like to load with an isometric exercise like Heel Digs:

Later on, we need to load the hip in various motions:

• Deadlifts
• Squats
• Lunges
• Rotational Squats
• RDLs
• Lateral Lunges

We have more information on a full program in one of our online classes on how to rehab thigh pain when running, if it’s not up already.

What kinds of treatments can be done for a Hamstring Strain?

Some great treatment options to decrease excessive scar tissue formation are listed below. It is extremely important to keep the scar mobile.

Scar tissue is not the enemy, but the lack of isolated pliability is.

• Active Release Technique
• Deep tissue massage
• Anti-inflammatory injections
• Prolotherapy
• Chiropractic adjustments or mobilizations
• PRICE therapy

Thigh pain when running

QUAD STRAIN

• Upper quad pain?
• Quad pain above knee?
• Thigh strain?

If you have been running higher volumes and hills, you could have a Quad Strain.

A Quad Strain can take up to four months to heal completely, but there are things you can do to accelerate the healing process.

Read on, and I’ll go over how we rehab and treat this condition to decrease thigh pain when running.

What is a Quad Strain?

The quads are a group of muscles in the front of the thigh that connect the hip and the knee. Three of the muscles only connect to the knee and are less susceptible to tearing: the vastus lateralis, vastus medialis, and vastus intermedius.

One muscle assists in flexion of the hip and for this reason, it is at the highest risk for strain during running. It is called the rectus femoris.

You may be wondering, “What does a strained quad feel like?”…

If you get a Grade I tear while running, it will feel like a band of the muscle is tight, like a guitar string.

If you get a Grade II tear while sprinting, it feels like someone shot you.

The quads run the whole length of the thigh, so it can feel like upper thigh muscle pain.

thigh pain when running

What causes a Quad Strain?

As I said before, most of the time, we are looking at a rectus femoris strain because it is the two-joint quad muscle.

A rectus femoris strain, just like two-joint hamstring tears, happens when you do not have proper function of the core/hips and improper running gait.

The rectus femoris attaches to the pelvis, which is supported by these muscle groups.

Proper gait allows the quads to do their job effectively and not become torn up, even with minimal workloads.

Thigh pain when running

How can you rehab a Quad Strain?

I like to start with some self-myofascial release. We use a lacrosse ball for this at the office and spend a few minutes on upper quad pain. This is better for Grade I Quad Strains.

If we are looking at a Grade II Quad Strain, then there is a 5-10 day resting period that’s needed before we can get too aggressive with deep tissue work. One clue that you’ve got a Grade II tear is if there is bruising.

Be aware that the blood goes the way of gravity; the bruising can even be found in the bottom of the foot!

The more advanced tissue work for upper thigh muscle pain can be found at a sports medicine office. Active Release and tool-assisted treatments are great.

Isometric (non-movement) exercise for the quad muscles is our next step to make sure the area is safe to load further.

Later on, we need to load the hip in various motions:

• Deadlifts
• Squats
• Lunges
• Rotational Squats
• RDLs
• Lateral Lunges

What kinds of treatments can be done for a Quad Strain?

Just as in Hamstring Strains, we need to keep the healing tissue pliable. If it is not, then it will re-tear again.

Here are some treatment options that I have found helpful for this:
• Active Release Technique
• Deep tissue massage
• Anti-inflammatory injections
• Prolotherapy
• Dry needling
• Chiropractic adjustments or mobilizations
• PRICE therapy

IT BAND SYNDROME

• Pain on the outside of the knee when bending?
• Worse when you start and stop at a light?
• Outer thigh “tightness”?

IT Band Syndrome (ITBS) is one of the top five injuries you can develop as a runner and it can present on the knee, thigh and hip.

I did a whole write up on IT Band Syndrome in our knee section, but many runners experience pain and tightness from ITBS on the outer part of the hip and thigh.

You may have tried an IT Band Strap?

They can help a lot, but remember passive devices are only doing what your body’s muscles should be doing on their own.

I won’t spend a lot of time on ITBS in this section since all of the information is in the knee portion HERE.

What causes IT Band Syndrome?

• Improper gait
• Decreased core strength
• Decreased hip strength
• Decreased glute strength
• Poor roads
• Old shoes
• New shoes

But overall…internal femoral rotation in the direct cause.

This is where the femur turns inward and changes the contact points of the knee bones, leading to a change of the path of the IT Band as well.

IT Band Runner

How can you rehab IT Band Syndrome?

We like to start with some self-myofascial release of the hips.

After, we like to work on some torso stabilization. IT Band exercises are really just core and hip ones.

Here is one we use for the hip rotators to control internal rotation of the thighbone (femur) when landing, which is what creates the rubbing.

There are so many more IT Band Syndrome exercises targeted at the hip than these I’ve listed here, so don’t think these are it.

When you have a well put-together program, there are progressions and variations of exercises. A circuit could take around 30 minutes.

Later on, we need to load the hip in various motions:

• Deadlifts
• Squats
• Lunges
• Rotational Squats
• RDLs
• Lateral Lunges

I don’t recommend doing these unless you really know what you’re doing. They are complex, and you would need to add weight to them, which increases the chance of further injury.

What kinds of treatments can be done for IT Band Syndrome?

IT Band Syndrome does not have excessive scar tissue formation unless it is a really old condition. In newer cases, we can still use some of the pain relief methods to give comfort, however it is important to know pain reduction doesn’t mean it’s time to throw down a long run.

It just means you are on your way to healing and we still need to improve your movements.

• Active Release Technique
• Deep tissue massage
• Anti-inflammatory injections
• Acupuncture
• Prolotherapy
• Chiropractic adjustments or mobilizations
• PRICE therapy

NERVE PAIN

• Burning sensation in the thigh above the knee?
• Numbness in the front of the thigh?
• Outer thigh muscle pain?
Thigh pain when running?

All off these can be signs of nerve pain.

It’s always very interesting to me when I examine a runner with nerve pain. Most of the time, they have tried thigh stretching, foam rolling, massage and more.

Why haven’t these helped? I explain to them that the issue is not with the thigh. There is nothing wrong with the muscles or flexibility of the hip and thigh, typically. It is all nerve pain.

This is hard to understand for most runners because they correlate the burning and numbness to use of the legs or their workouts.

And yes, this does make sense, but again, the presentation is more of a nerve pattern, which means if you are spending time stretching and foam rolling your thigh, you are wasting your time.

I have seen this many times in my clinic, and once we stabilize the trunk, it often improves very quickly.

In this article, I will go over educational information you need to know about burning thigh pain as a runner and what we do for rehab.

What is Nerve Pain?

A good analogy for nerve impingement is the act of stepping on a hose. The place where you clamp your foot down is a pinch point.

Just like the hose, the effect of a pinch point on a nerve can be evident along the whole distance of its course.

Still hard to understand?

Think of a heart attack. When someone has a heart attack, they normally have face and left arm pain, right?

Do we ever foam roll in a heart attack?

No, of course not.

Nerve pain is the same. The pain refers and travels. It is best not to chase it and miss the site of impingement.

What causes Nerve Pain?

Nerve pain is a direct result of a nerve that’s being compressed.

Compressed by what? This is up for debate.

It could be from within or outside of the spine. Some possible things that can cause compression are:

• A disc herniation
• Central Stenosis
• Foraminal Stenosis
• Spinal tumor
• A thigh piriformis
• A tight hip flexor (iliopsoas muscle)
• Tight hamstrings
• Scar tissue

You may be thinking Sciatica?

Sure, Sciatica is a reason for numbness of the buttocks, thigh, calf and foot, but it is not the only reason for nerve pain.

One video I put on YouTube years back was about femoral nerve entrapment, which yielded “Sciatica-like” numbness and pain, but on the front side of the thigh.

Here’s the video.

You may be wondering if running could aggravate Sciatica and Femoral Nerve Entrapment?

Sure it can.

Remember, the nerve is being compressed… somewhere… and if that area tightens further via bones moving or muscles becoming tight, then the burning will increase.

Does this mean Sciatica, or any nerve pain for that matter, should stop you from running?

Depends…my answer is always it depends.

• Can you keep your core stable?
• Can you control an increase in the nerve pain when running?
• Will you stop if the group is getting ahead of you?

If you cannot do these things, then the firm answer is no.

How can you rehab Nerve Pain?

The first thing we start with for nerve pain from running is to establish if it gets worse with isolated spinal motion, isolated hip motion or both.

If it is isolated spinal motion, we then need to find if it is more TOLERANT to spinal flexion or extension.

Don’t understand this? Here is a our podcast on the topic. “Do not pass Go” and “Do not collect $200” if you do not understand this concept.

If we find it is extension tolerant, we start with something like a Birddog exercise because it gets into low back extension. If we are correct, this therapy exercise will feel very comfortable but challenging.

If the injury likes flexion, we would start with a Dead Bug.

If we have found motion of the low back does not increase or decrease pain, but the hip does, we would go towards deep tissue mobilization of the soft tissues of the hip followed by strengthening of the core and hip.

I hope that makes sense, but it is not as clear-cut as other injuries. There is a lot of trouble shooting.

To be clear: therapy of nerve pain from running is very specific to the cause of compression. If we do not know the compression point, your rehab will be a waste of time.

Find the cause first.

What kinds of treatments can be done for Nerve Pain?

Treatments for releasing the pinch point vary based upon their origin whether it’s spinal entrapment or something outside of the spine.

Extra-spinal (outside the spine) entrapment will respond to nerve flossing techniques and deep tissue work.

For this I would use:

• Active Release Techniques
• Instrument-assisted tissue work
• Nerve flossing stretches
• Mobility activities for the hip

Spinal entrapments will not respond in the same way.

I would work more towards trunk stabilization exercise and add mobility around the lumbar spine.

To do this, I would use:

• Lewit
• Dead Bugs
• Birddogs
• McKenzie Extension Series
• Rope Stretching of the hip
• Thoracic spine mobility exercises

The pain relief therapies are all still in play as well.

• Anti-inflammatory injections
• Acupuncture
• Prolotherapy
• Electrotherapy
• Chiropractic adjustments or mobilizations
• PRICE therapy

Thigh pain when running does not have to be your reality. It can be treated and rehabbed to get you running again in 9 out 10 cases.

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